S2718 Harmful Gains: Drug-Induced Liver Injury From Selective Androgen Receptor Modulators

Baliss, Michelle; Kline, Kevin; Merwat, Sheharyar

doi:10.14309/01.ajg.0000712920.97943.a8

Cited by 4 publications

(14 citation statements)

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“…As a result, they can have similar outcomes as AASs, resulting in three types of liver injury due to augmented cell growth, which include hepatic tumors, peliosis hepatis, and nodular regenerative hyperplasia. Due to the increase in the use of SARMs, it is essential to report these cases as early as possible to help recognize the offending agent and to understand its long-term effects [6].…”

Section: Discussionmentioning

confidence: 99%

“…Unlike AASs, which have both anabolic and androgenic properties, SARMs express positive effects on muscles and bones without causing any androgenic effects of AASs. Due to these favorable properties, they are also marketed by some supplement manufacturers as legal steroids and also being desiccated for the management of osteoporosis, cachexia, and sarcopenia [4][5][6]. Although FDA and world anti-doping agency have not approved the use of SARMs, they are very popular among athletes and are heavily promoted as AAS alternatives [3,5].…”

Section: Introductionmentioning

confidence: 99%

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Selective Androgen Receptor Modulator Induced Hepatotoxicity

Khan¹,

Fackler²,

Gilani³

et al. 2022

Cureus

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Selective androgen receptor modulators (SARMs) have been developed as an alternate to traditional anabolic steroids due to their favorable effects on the bones and muscles without androgenic side effects. They are very popular among athletes and bodybuilders and are available online or over the counter. The FDA has warned of their side effects including liver injury. Here we present the case of a 29-year-old patient who presented with jaundice, fatigue, and elevated liver function tests after starting SARM supplements. His symptoms improved and eventually resolved with stopping the supplements. The purpose of this case report is to raise awareness and educate clinicians of the potential side effect of hepatotoxicity of these supplements that can help in its early identification and management.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Selective Androgen Receptor Modulator Induced Hepatotoxicity

Khan¹,

Fackler²,

Gilani³

et al. 2022

Cureus

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“…Aside from bodybuilding supplements, the men were not using other medications except for one who was on venlafaxine and another who was on zopiclone and finasteride. 14,15,18,20,21,28,29,37,67,68 The demographics of patients with DILI from SARMs were highly consistent with the demographics of DILI from AAS. From 1994 to 2013, all cases of DILI from AAS in the Spanish DILI Registry and Latin DILI Network were in men from 20 to 49 years of age with a mean of 32 years.…”

Section: Epidemiologymentioning

confidence: 53%

“…Latency period in idiosyncratic injury can vary as was seen in a number of SARM-related DILI cases in which the time to symptoms onset ranged from approximately 4 to 12 weeks. [27][28][29] Outside of the acute cholestatic syndrome, clinical trials have shown that SARMS have the potential to induce transient liver enzyme elevations that have resolved without discontinuation of the drug. 30,31 17α-alkylated AASs have also been linked to transient serum elevations that resolve without discontinuation.…”

Section: Hepatotoxicitymentioning

confidence: 99%

“…However, taking into consideration that SARMs have a similar anabolic potential for growth stimulus on tissues, these manifestations of liver injury are plausible with prolonged, high-dose SARM use. 29,37 Although these various forms of toxicity have been primarily observed with oral steroids and oral SARMs, the effects have less frequently been observed with intramuscular injections of AAS. 7 While not approved and not studied in any clinical or preclinical trials, injectable SARMs have made their way into the bodybuilding communities and can be purchased online.…”

Section: Hepatotoxicitymentioning

confidence: 99%

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Selective Androgen Receptor Modulators: An Emerging Liver Toxin

Mohideen¹,

Hussain²,

Dahiya³

et al. 2023

J Clin Transl Hepatol

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Selective androgen receptor modulators (SARMs) are a class of nonsteroidal drugs that are favored over anabolic androgenic steroids (AASs) for their tissue-selectivity and improved side-effect profile. These drugs have been evaluated for treatment of various diseases including muscle-wasting disorders, osteoporosis, and breast cancer. Despite lacking approval for therapeutic use, SARMs are widely used recreationally as performance enhancing drugs by bodybuilders and athletes. In recent years, cases of drug-induced liver injury (DILI) secondary to SARMs have begun to emerge, but little is known regarding their hepatotoxicity. In this review, we provide current knowledge regarding DILI from SARMs. A literature search was conducted regarding SARMs and liver injury to evaluate relevant cases and information. SARMs have been associated with a cholestatic syndrome congruent with that of DILI from AASs, and it consists of a bland cholestasis in which there is minimal bile duct injury, inflammation, or necrosis. Patients present with an insidious onset of jaundice with marked hyperbilirubinemia and mild hepatic enzyme elevations. No clear treatment exists, although patients typically show improvement with cessation of the offending SARM. Given the novelty of these drugs, further study is necessary to understand diagnosis, management, and complications of SARM-related DILI.

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Selective androgen receptor modulator use and related adverse events including drug-induced liver injury: Analysis of suspected cases

Leciejewska,

Jędrejko,

Gómez-Renaud

et al. 2023

Eur J Clin Pharmacol

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Purpose Selective androgen receptor modulators (SARMs) have demonstrated agonist activity on the androgen receptor in various tissues, stimulating muscle mass growth and improving bone reconstruction. Despite being in clinical trials, none has been approved by the Food and Drug Administration (FDA) or European Medicines Agency for pharmacotherapy. Still, SARMs are very popular as performance-enhancing drugs. The FDA has issued warnings about the health risks associated with SARMs, but the long-term exposure and possible adverse events still need to be fully understood. This review aims to evaluate the adverse events associated with using SARMs by humans. Methods PubMed database was searched from September 16, 2022, to October 2, 2023. In total, 20 records were included in the final review. Data from preclinical and clinical studies supported the review. Results Since 2020, 20 reports of adverse events, most described as drug-induced liver injury associated with the use of SARM agonists, have been published. The main symptoms mentioned were cholestatic or hepatocellular liver injury and jaundice. Limited data are related to the dosages and purity of SARM supplements. Conclusion Promoting SARMs as an anabolic agent in combination with other performance-enhancing drugs poses a risk to users not only due to doping controls but also to health safety. The lack of quality control of consumed supplements makes it very difficult to assess the direct impact of SARMs on the liver and their potential hepatotoxic effects. Therefore, more detailed analyses are needed to determine the safety of using SARMs.

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S2718 Harmful Gains: Drug-Induced Liver Injury From Selective Androgen Receptor Modulators

Cited by 4 publications

References 0 publications

Selective Androgen Receptor Modulator Induced Hepatotoxicity

Selective Androgen Receptor Modulator Induced Hepatotoxicity

Selective Androgen Receptor Modulators: An Emerging Liver Toxin

Selective androgen receptor modulator use and related adverse events including drug-induced liver injury: Analysis of suspected cases

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